MEDICARE: LAKE HIGHLAND IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1821378845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE HIGHLAND IMAGING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 674282
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-4282
Country	:	US
Telephone Number	:	972-479-1115
Fax Number	:	972-479-1118

Provider Business Practice Location Address
First Line	:	9440 GARLAND RD
Second Line	:	SUITE 190
City	:	DALLAS
State	:	TX
Zip	:	75218-5003
Country	:	US
Telephone Number	:	214-388-2030
Fax Number	:	214-388-0645

Authorized Official
Title or Position	:	MANAGER
Name	:	JAMES WEBB
Credential	:
Telephone Number	:	469-368-6909

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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